Melphalan flufenamide (melflufen)

Also known as: Pepaxto

Not FDA-approved

Last verified: October 30, 2026

At a glance

FDA approval Not FDA-approved No record in Drugs@FDA
Randomized controlled trials 3 of 81 publications on PubMed
Registered clinical trials 11 1 active
Adverse event reports 113 79 classified as serious
  • Melphalan flufenamide (melflufen) is not an FDA-approved drug: Drugs@FDA has no record of it.
  • PubMed lists 81 publications mentioning it, including 3 randomized controlled trials and 2 animal-only studies.
  • ClinicalTrials.gov lists 11 registered studies testing it (1 active).
  • FDA's adverse event system (FAERS) holds 113 reports mentioning it; 79 classified as serious. Reports do not prove causation.

Research topics

  • Multiple Myeloma 48
  • Phenylalanine 42
  • Antineoplastic Combined Chemotherapy Protocols 30
  • Dexamethasone 21
  • Antineoplastic Agents, Alkylating 12
  • Neoplasm Recurrence, Local 8
  • Antibodies, Monoclonal 7
  • Antineoplastic Agents 7
  • Drug Resistance, Neoplasm 7
  • Recurrence 7

Most frequent MeSH subject headings in the latest PubMed records (English, as indexed).

Regulatory status

Drugs@FDA applications

No application found in Drugs@FDA, FDA's database of approved drugs.

Source: Drugs@FDA (openFDA) · verified October 30, 2026 · API query

FDA compounding safety list

Not on FDA's list of bulk drug substances that may present significant safety risks in compounding.

Source: FDA.gov — Category 2 bulk drug substances · verified October 30, 2026

Removal of a substance from a regulatory list does not mean it has been approved. A "research use only" label does not make a product safe or legal for human use.

Scientific publications

  • All publications 81
  • Human (MeSH) 56
  • Animal only 2
  • Clinical trials 12
  • Randomized controlled trials 3
  • Systematic reviews & meta-analyses 0
  • Case reports 1
  • Retracted 0

Counts are PubMed records that mention the peptide in the title or abstract. Categories overlap, and a mention is not the same as testing the peptide as a treatment. Each number opens the exact PubMed search. Effects seen in laboratory or animal studies may not occur in humans. A registered clinical trial does not show that a substance is effective or safe.

Latest publications

Source: PubMed (NCBI) · verified October 30, 2026

Clinical trials

Registered
11
Active
1
With posted results
7

Conditions studied

  • Multiple Myeloma 5
  • Relapse Multiple Myeloma 1
  • Relapsed Multiple Myeloma 1
  • Relapsed-Refractory Multiple Myeloma 1
  • AL Amyloidosis 1
  • RRMM 1
  • Renal Impairment 1
  • Relapsed and/or Relapsed-refractory Multiple Myeloma 1
  • Relapsed and/or Refractory Multiple Myeloma 1
Study Status Phase Start
A Non-interventional Study of Melphalan Flufenamide (Melflufen) (Pepaxti®) and Dexamethasone in Patients With Relapsed and/or Refractory Multiple Myeloma (R/RMM)
NCT07559799 iOMEDICO AG
Recruiting — June 1, 2026
Melflufen for Elderly Patients With Relapsed Myeloma
NCT06682637 Fondazione EMN Italy Onlus
Withdrawn Phase 2 March 26, 2025
Study of Melflufen (Melphalan Flufenamide) in Combination With Daratumumab in Relapsed-Refractory Multiple Myeloma
NCT04649060 Oncopeptides AB Results posted
Terminated Phase 3 December 21, 2020
A Clinical Study of Melphalan Flufenamide (Melflufen) and Dexamethasone for Patients With Immunoglobulin Light Chain (AL) Amyloidosis
NCT04115956 Oncopeptides AB
Terminated Phase 1 August 6, 2020
A PK, Safety and Tolerability Study of Peripheral and Central Infusion of Melflufen in RRMM Patients
NCT04412707 Oncopeptides AB Results posted
Terminated Phase 2 August 4, 2020
PK of Melphalan During Treatment With Melflufen and Dexamethasone in Patients With RRMM and Impaired Renal Function
NCT03639610 Oncopeptides AB Results posted
Terminated Phase 2 August 28, 2018
Study of Melphalan Flufenamide (Melflufen) + Dex With Bortezomib or Daratumumab in Patients With RRMM
NCT03481556 Oncopeptides AB Results posted
Terminated Phase 1, Phase 2 April 12, 2018
A Study of Melphalan Flufenamide (Melflufen)-Dex or Pomalidomide-dex for RRMM Patients Refractory to Lenalidomide
NCT03151811 Oncopeptides AB Results posted
Terminated Phase 3 June 12, 2017
A Study of Melphalan Flufenamide (Melflufen) Plus Dexamethasone in Patients With Relapsed or Refractory Multiple Myeloma
NCT02963493 Oncopeptides AB Results posted
Completed Phase 2 December 28, 2016
Safety and Efficacy of Melflufen and Dexamethasone in Relapsed and/or Relapsed-Refractory Multiple Myeloma Patients
NCT01897714 Oncopeptides AB Results posted
Terminated Phase 1, Phase 2 Jul 2013
Show 1 more study
Study Status Phase Start
Expanded Access Program for Melphalan Flufenamide (Melflufen) in Triple Class Refractory Multiple Myeloma
NCT04534322 Oncopeptides AB
Approved for marketing — —

All 11 studies on ClinicalTrials.gov ↗

Source: ClinicalTrials.gov · verified October 30, 2026

Adverse event reports

Reports
113
Serious
79
With death outcome
30

Most reported reactions

  • Cytopenia 19
  • Drug ineffective 18
  • Sepsis 17
  • Off label use 14
  • Hypotension 13
  • General physical health deterioration 11
  • Platelet count decreased 11
  • Plasma cell myeloma 10
  • Febrile neutropenia 9
  • Nausea 9
  • Malignant neoplasm progression 8
  • Plasma cell myeloma refractory 8

Adverse event reports do not prove that the substance caused these effects. Side effects not listed here may still occur. Reaction terms are MedDRA terms as reported to FAERS.

Source: FDA FAERS (FAERS data as of July 30, 2026) · verified October 30, 2026 · API query

Change history

No changes since monitoring began on October 30, 2026.